Severely disrupted by the COVID-19 pandemic, medical schools are gearing up to reopen in the near future. At a press conference on Friday, officials of the Association of American Medical Colleges (AAMC) provided updates. Two thirds of the 155 accredited US medical schools recently provided the AAMC with information on their plans to reopen, said Alison Whelan, MD, chief medical education officer of the association. In mid-March, nearly all medical schools removed students from direct patient care in order to flatten the COVID-19 curve and conserve personal protective equipment (PPE). Students have continued to take courses online, but that alone falls short of the requirements for graduation. Of the medical colleges that informed the AAMC of their plans, 15% plan to restore students to clinical care by the end of May, 55% by the end of June, and 77% by the end of July. Fifteen percent of the schools are finalizing their plans, Whelan said. "Returning students to direct patient contact, like reopening communities, is a delicate balancing act," she noted. "Schools want to get students back to patient-centered learning, so they can continue progress toward on-time graduation in 2021 and 2022. But critical considerations, including patient safety and not triggering a second surge, must be taken into account." Medical colleges must also ensure that there are opportunities for meaningful learning, Whelan said. "In areas where there are a lot of COVID patients, the physicians who typically supervise these medical students may have zero time and zero capacity to teach. In those areas where elective surgeries and routine office visits are severely restricted, there may be very few patients to learn from." Internships on Track, In-Person Instruction on Hold Whether or not medical schools will resume classroom instruction in the fall will depend on the local severity of the pandemic, as well as on state and national guidelines, Whelan noted. "If there are recommendations for social distancing, they won't be bringing students back into large classrooms." Moreover, she said, there's no immediate need for in-person instruction "because the medical schools have been very successful with online learning. So they'll go back when they think it's safe, but there's not a huge urgency for that because virtual and online distance learning has been found to be effective." Asked whether medical school graduates will start their internships on July 1, as usual, Whelan said, "The expectation in the medical community is that these new students do need to enter their residency programs in a timely fashion." To make that happen, she said, a workgroup that includes the AAMC has been discussing key issues, such as the transportation of students to hospitals in other areas and whether they need to be quarantined before they start. Meanwhile, students from more than 20 medical schools have been given the opportunity to graduate early in order to join the fight against COVID-19. "The vast majority of those students are working in their local hospitals and were granted special licenses for supervised practice," Whelan said. Grim Present, Bright Future Despite the gloom and doom enveloping physicians at present, the AAMC has seen signs that many idealistic young people are still eager to go into medicine. On May 6, when the AAMC opened up MCAT registration, which had been postponed in March and April because of stay-at-home orders, 62,000 people registered online, up from 10,000-12,000 on the first day of registration last year, said Gabrielle Campbell, chief services officer of the AAMC. The system initially crashed under the load but was fixed in a few hours. All 62,000 applicants successfully registered and were able to choose the time and place for their tests. The registration for the American Medical College Application Service, which initiates applications to medical schools, began on March 4. In the first 3 days, Campbell said, there was a 50% increase in the number of people who started their applications compared with the same period last year. "This doesn't necessarily mean more people will be applying in this application year, but we're cautiously optimistic about it," she said. David Skorton, MD, president and CEO of the AAMC, likewise said, "We're very encouraged by students' strong interest in registering for the MCAT exam. We're starting to see hints of strong interest in people entering the field overall, even though it's quite early in the medical school application process. That is a great sign if that preliminary trend continues, because our country needs more doctors." How Hospitals Will Reopen Medical education, of course, is inseparable from hospitals, specifically the academic medical centers where most students and residents are trained. Treating patients with COVID-19 is currently taking center stage in most hospitals, and many states have ordered healthcare facilities and physicians to delay elective or nonurgent procedures. However, the Centers for Medicare and Medicaid Services in mid-April issued recommendations for reopening facilities to provide nonemergent care to patients without symptoms of COVID-19. A number of states have also relaxed their prohibitions to some extent. At the AAMC briefing, Janis Orlowski, MD, chief healthcare officer of the association, said, "As we talk to medical leaders, we're hearing that some urgent cases have become more emergent. Those are the first cases we'll start to see in the hospitals." However, she noted, hospital leaders have said in conference calls that they plan to reopen their institutions slowly. For example, Indiana University Health is planning to increase the number of patients in its hospitals by no more than 25%. "They will stop at that point and reassess before opening up further," Orlowski said. Among the concerns on the minds of hospital executives, she said, are the local burden of the disease, whether there is adequate testing and PPE, and whether there are enough ICU beds available "in case they have to pivot. Hospitals have to be prepared to pivot as needed if there's a local or national surge [of COVID-19]." Source
